neonatal jaundice

Neonatal jaundice

Jaundice in babies usually occurs because of a normal increase in red blood cell breakdown and the fact that their immature livers are not efficient at removing bilirubin from the bloodstream.Most jaun

dice in newborn babies is a normal event and is not serious. In most cases, this jaundice will disappear after a few days, often without any special treatment. Jaundice in the infant appears first in the face and upper body and progresses downward toward the toes. Premature infants are more likely to develop jaundice than full-term babies.Most babies with jaundice have physiologic jaundice. This is the type of jaundice that is caused because of the natural process of breaking down red blood cells.

what causes jaundice

There are at least two significant processes that predispose normal infants to jaundice:

  • The rate of bilirubin production is higher in infants than adults because their red blood cells have a shorter half-life and turn over more rapidly.
  • Infants have a relatively limited ability to conjugate bilirubin, and conjugation in the liver is necessary for efficient elimination.

Additionally, there are a number of pathologic conditions that can result in neonatal jaundice. It include:

  • Conditions that cause accelerated destruction of red cells, which can occur as a result of immune-mediated hemolysis, certain enzyme deficiencies, or structural abnormalities in red cells.
  • Increased intestinal absorption of bilirubin, which blunts the infant’s ability to eliminate this waste product. Infants that fail to feed well are often deficient in the types of intestinal bacteria that metabolize bilirubin, and in such cases, significant amounts of bilirubin of reabsorbed into blood.
  • Genetic defects in hepatic uptake of bilirubin (e.g. Gilbert’s syndrome) or deficiency in the enzyme necessary for conjugating bilirubin (uridine diphosphate glucuronosyltransferase).
other cause of new born jaundice include Breast milk jaundice. This condition may persist as a prolonged physiological
jaundice or it may appear for-the first time after the first week. It is common in solely breast fed babies and the intensity is maximum between 10-14 days of life. But if bilirubin is > 15 mg/dl at 3 weeks, cessation of breast milk for 48 hours will decrease bilirubin levels dramatically and breast milk can be resumed without any risk of recurrence of jaundice.
Risk factors of jaundice
A simple pneumonic for risk factors of jaundice is JAUNDICE
J – Jaundice within first 24 hrs of life
A – A sibling who was jaundiced as neonate
U – Unrecognized hemolysis
N – Non-optimal sucking/nursing
D – Deficiency of G6PD
I – infection
C – Cephalhematoma /bruising
E – East Asian/North Indian
Symptoms of jaundice
The main symptom is a yellow color of the skin. The yellow color is best seen right after gently pressing a finger onto the skin. The color sometimes begins on the face and then moves down to the chest, belly area, legs, and soles of the feet. sometimes jaundice cause extreme tiredness and poor feeding.
Newborn Jaundice Diagnosis
Before a baby can be treated, a careful examination by a pediatrician is all that is needed. The serum bilirubin level may be checked. A Coombs test checks for antibodies that destroy an infant’s red blood cells. Complete blood count and Reticulocyte count should be done.
Newborn Jaundice Medical Treatment
jaundice is often treated with phototherapy. These lights are able to penetrate a baby’s skin and affect the bilirubin within the child. The light changes bilirubin into lumirubin, which is easily handled by the baby’s body. If phototherapy doesn’t work to reduce a baby’s bilirubin level the baby may be placed on a fiber optic blanket and an additional bank of lights may be added.
When all other treatments have failed to reduce the bilirubin level , then exchange transfusion should be done. In this treatment, the baby’s blood is exchanged with donated blood.
Newborn Jaundice Self-Care at Home
1) Sunlight – Place the child in a well-lit window for 10 minutes twice a day is often all that is needed to help cure mild jaundice. Never place an infant in direct sunlight.
2) photo therapy – If the bilirubin level is too high, the child may need to be placed under a special type of light. This treatment is called phototherapy. such lights can be set up at our home with careful monitoring

Article publié pour la première fois le 23/12/2011

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